Provider Notice issued 11/4/11

To: Participating Hospitals, Physicians, and Imaging Centers

Date: November 4, 2011

Re: Independent Diagnostic Testing Facilities

The purpose of this notice is to inform providers that 89 Illinois Administrative Code, Section 140.438 has been revised to allow Independent Diagnostic Testing Facilities (IDTF) to enroll as providers with the HFS' Medical Programs. This rulemaking sets forth the requirements that must be met for IDTF services to be eligible for reimbursement from HFS.

Enrollment Requirements

•  Providers wishing to enroll as an IDTF must submit the following paperwork.
• Form HFS 2243 (pdf) (Provider Enrollment/Application Form)
• Form HFS 1413 (pdf) (Agreement for Participation)
• Form HFS 1513 (pdf) (Enrollment Disclosure Statement)
• W9 (Request for Taxpayer Identification Number)

A copy of the Medicare approval letter and CMS 855B, Attachment 2

The forms must be completed (printed in ink or typewritten), signed and dated in ink by the provider, and returned to the Provider Participation Unit at the address listed below.

Healthcare and Family Services
Provider Participation Unit
Post Office Box 19114
Springfield, Illinois 62794-9114
Fax Number: 217-557-8800

The date on the application will be the effective date of enrollment unless the provider requests a specific enrollment date. HFS will allow a retroactive date of July 25, 2011, which was the effective date of the administrative rule adoption.

Billing Requirements

IDTFs may bill for the technical component, professional component or globally for the diagnostic or imaging services they are certified by Medicare to provide. Information regarding billing for the technical component, professional component or globally may be found on the Practitioner Fee Schedule Key. IDTFs may bill electronically or on the HFS 2360 paper claim form. Providers wishing to submit 837P electronic transactions must refer to Chapter 300, Handbook for Electronic Processing for information that is specific to conducting Electronic Data Interchange (EDI) with HFS. Billing instructions for the HFS 2360 may be found in Chapter 200, Handbook for Practitioners Rendering Medical Services, Appendix 1. Medicare/Medicaid crossover claims may be billed on the HFS 3797. Billing instructions for the HFS 3797 may be found in Chapter 200, Handbook for Practitioners Rendering Medical Services, Appendix 2.

Questions may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator
Division of Medical Programs

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